Atlas Shrugged: The Mocking

Saturday, February 27, 2010

The New And Improved Atlantic!

Obviously, the changes to The Atlantic were made to increase the number of hits, since we are forced to increase the number of hits we make to read McArdle's work. This is very, very interesting. Why is The Atlantic, which has never made money, trying to make more money? In 2008, the president of Atlantic Media was quoted: "The magazine is still in the red, in the $3-to-$5-million range, but he hopes to be in the black in five years." Is it necessary, or is David G. Bradley just trying to maximize the relatively small revenue that comes from the on-line magazine?

The new format is also filled with bugs.

Meanwhile, most of the more sane members of the comment section seem to have given up, leaving it to the rabid libertarians, who attack and gnaw at the few remaining less rabid libertarians like jackals at a corpse.

Also meanwhile, nearly two weeks after McArdle published "Myth Diagnosis," she has yet to directly answer her critics. McArdle's posts supporting her stupidity (Nine! Count 'em! Nine! Lovely supporting posts!) mostly restate her stupidity rather than backing it up with facts.

So while it's entirely possible--indeed certain--that some number of people are saved by having insurance, it's also very likely that some number of people are saved by not having it, or having less generous insurance, because they don't go in for a treatment that would have killed them.

The 2009 paper was looking at a small subset of conditions that are urgent, and which we're relatively adept at treating. But it may be washed out by the people who die having knee surgery.

I thought I'd made it clear, but apparently not: I think it is possible that the lack of insurance has no effect on aggregate mortality statistics. I do not think that this is likely, but I think it's possible. What I think is likely is that the effect is not that large, because if it were large, it would be very surprising to see so little effect on the mortality of an elderly population with a high mortality rate, or to have a study that samples 600,000 people and finds no effect.

Mostly what I think is that the statistics are really, really flawed. Not because the authors are bad social scientists, but because this stuff is so hard to tease out. Natural experiments are rare, and data sets often hard to come by.

What I said is, the studies so far done often cannot exclude the possibility that there is no effect--this is true of one of the two studies that IOM/Urban relied upon, and also of the largest observational study done to date, which found no effect. That is not the same as saying there is no effect. Health data, like economic data, is very noisy. Sometimes effects that we're pretty sure exist just can't be easily teased out of the data . . . like, oh, I dunno, the effectiveness of fiscal stimulus, say.

What I am saying is that we don't know how big the effect is. Refuting me involves, not saying that well, here's another study showing some effect, but rather, taking a stand and saying we do know how big the effect is, or at minimum, that we can prove it's probably at least 20,000 people a year, the figure I was discussing.

McArdle promised to answer her critics within a few days, but that was about a week ago, so it must have slipped her wedding-occupied mind.

This blog may never be exactly what you want. Let's be honest: I work for a commercial organization, and in order for them to continue to pay my paycheck, this site needs to be profitable. So we're going to have ads and other features that may well annoy you from time to time.

It's going to have to be a lot more profitable to make up a $3-5 million shortfall.

Holy crap. I read that first quotation and thought, "Even McArdle can't be that dumb," but of course I should know better by now.

In post #3, she tries to argue that people pointing out that she's making a dumb argument are attacking a straw man, and tries to redefine the "debate," a move she often tries:

What I am saying is that we don't know how big the effect is. Refuting me involves, not saying that well, here's another study showing some effect, but rather, taking a stand and saying we do know how big the effect is, or at minimum, that we can prove it's probably at least 20,000 people a year, the figure I was discussing.

So to recap, her argument becomes:

1. Some people die because of botched medical care.2. Hey, maybe, just maybe, that number is higher than the number of people who die due to a lack of medical care altogether!3. Until we know for sure that lack of medical care kills more people than botched care, it would be terribly irresponsible to give people medical coverage!4. Unless my critics answer #3 to my satisfaction (and never mind that I'm arguing in bad faith), I win! Yay me!

One answer is, screw you, McArdle. Like all obstructionist hacks, she's just flinging shit and hoping something, anything, will stick. Another answer is, it doesn't matter. Or more specifically, McArdle doesn't matter to this issue, because the people who give a damn are already looking at it. Yet another answer is, her entire argument ignores two major factors, as she always does. 1) Death is important, but it's ridiculous to argue that basic health care doesn't improve quality of life in essential ways. Someone nearsighted, or with a painful toothache, or with crippling allergies, or a cleft palate and unable to speak, will be much better off with care than without it. It's not incidental that many basic care treatments have little to no chance of killing the patient. 2) We have cheaper, better health care in major countries around the world to look at as a model. Reality already tells us that enacting the changes she opposes will not make the heavens fall ("it'll stifle innovation, according to stats I just made up!") as she constantly warns or trolls. It's not as if medical stats for Britain, Japan, France, etc. are a big secret.

McArdle's original piece is what she's done for the past couple of years – she concern trolls health care reform, because she doesn't want it to pass, and she just makes up shit as she goes to justify her opposition (or to justify her "concern" if she's being less honest).

How many people die per year due to lack of health care? McArdles's right it's hard to judge, but studies I've seen put the number anywhere from 22,000 to 45,000 per year. How many people die due to botched care? How many people die during life-saving measures that prove ineffective? Medical professionals can and do grapple with those. That medical checklist can cut mistakes significantly. But the people who give a damn are already looking at it. As always, McArdle's discomfort over health care reform due to [insert latest excuse here] is not a valid or sound reason against reform.

If McArdle doesn't want to be criticized, she shouldn't offer such lousy arguments. She can keep playing the "Hey guys, have you considered this?" game as long as she wants, but the reality is something like a) they are considering it, albeit more intelligently than McArdle, b) they've already considered it and made their conclusion, c) they've considered it for a minute and dismissed it out of hand as absolutely idiotic. The sincere, good faith, reality-based adults have been having conversations about improving medical care all along – she's just never been a part of it.

(I've been working on a few new posts on health care, and will have to come back to this latest shit series from McArdle...)

Ezra Klein asked her why she didn't drop her employer-provided coverage and she said:

"Ezra asks why, if I think the benefits of health insurance are so minimal, I have health insurance. Revealed preference! Gotcha!

But the answer as to why I have health insurance is simple: my employer pays for it. If my employer didn't pay for it, I wouldn't have it. I'd buy a catastrophic policy from a reputable insurer to cover any amount that might bankrupt me, and self-insure for everything else. That would probably cost me a little more than what I pay The Atlantic for my first-dollar coverage, so I opt for the first-dollar coverage. It's not like I get the money The Atlantic is spending on my benefits back if I choose to go without....

I'm pretty sure my life would be, on net, better if I had the cash wages and a catastrophic policy instead of the health benefits....

If I suddenly lost my health insurance, I would still be a comfortably middle class person who would pay my doctor's bills out of pocket, and wouldn't miss an important checkup with the pulmonologist or the immunologist. I would be, well, pretty much like I was during the years that I was uninsured, and spending quite a large portion of my meager earnings on doctors bills. I might end up bankrupt. But outside of the kind of fluke that afflicts any system from time to time, I would not end up dead."

So she says she'd buy catastrophic insurance and "self-insure," which she very well knows is much more expensive. But she doesn't have to, so she doesn't. Despite the fact that health insurance reform will kill millions, Megan is benefiting, and why should she do any different?